THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDIAL INFORMATION ABOUT YOU IS DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to keep you health information private and provide you with a copy of this Notice. We are also required by law to follow the terms of this Notice as long as it is in effect. If you have any questions about this Notice, please contact the Lisbon Fire Department at: 262-246-6401 or The Lisbon Town Hall at: 262-246-6100.
Who Will Follow This Notice?
All members of the Lisbon Fire Department and The Lisbon Town Hall that handle billing information.
This Notice applies to all records relating to your care and ambulance transport that we maintain. However, please note that the hospital and their personnel have separate policies and/or notices about disclosure of health information.
How We May Use And Disclose Health Information About You.
1. We may use and disclose health information about you to:
a. Provide you with medical treatment or services. We may need to share health information about you with people outside of our organization to include family members, health agencies, or others we use to help provide services, unless you 0bject.
b. Bill and collect payment from you, an insurance company or a third party.
c. Assist us with our healthcare operations. For example, we may use health information about you to review our treatment and services and/or to evaluate the performance of our staff.
2. We may share health information about you with family members or friends whom you indicate are involved in your medical care. In certain disasters and related emergency situations, we share health information about you with disaster relief organizations so that your family can be notified about your condition, status and location.
3. We may use or disclose health information about you without your permission only as allowed by law. Examples of situations where we may be required to release health information about you include: emergencies, public health, health or safety threats, reporting abuse or neglect, audit activities, national security, coroners, medical examiners, funeral directors, organ/tissue donation, and workers’ compensation. We may also be required by the law to provide health information about you in response to requests from law enforcement officials in limited circumstances, correctional institutions, or as part of legal proceedings in response to valid judicial or administrative orders and/or other valid legal authority.
Other Uses of Health Information.
Uses or disclosures of your health information that are not covered by this Notice or the law will be made only with your written permission. You may take your permission, you must do so in writing and we will no longer use or share the health information you specified for the reasons you noted in writing. You understand that when you take back your permission we are unable to retrieve any information we may have already shared with your permission.
Your Rights Regarding Health Information About You.
1. You have the right to see and receive a copy of health information about you. To do so, you must submit your request in writing to either The Town of Lisbon Hall or the Town of Lisbon Fire Department. If you request a copy, it must be requested in advance and we may charge a fee for the cost of copies, postage and/or other supplies. In certain situations, we may deny your request. If we deny your request, we will tell you, in writing, why your request was denied and explain to you your right to have the denial reviewed.
2. If you feel that our record of your health information is incorrect or incomplete, you have the right to request to amend the information. You may do this by sending your request in writing to The Lisbon Town Hall or the Lisbon Fire Department. We may deny your request if the information was not created by us, is not part of the health information maintained by us, or if it is determined that the health information is correct. You may appeal our decision by sending a written request to us.
3. You have the right to request a list of all of our disclosures you specifically authorized. To request this list, you must send your request in writing to the Town of Lisbon or the Lisbon Fire Department. Your request must tell us a specific time period (beginning after April 14th, 2003) of not more than six years. We may charge a fee for these lists.
4. You have the right to ask us to send information to you at a different address, or in a different way. You may do so by requesting in writing.
5. You have a right to receive a paper copy of this Notice.
6. You have the right to ask that we limit how we use and disclose health information about you.
Complaints
If you feel that your privacy rights have been violated, you may file a complaint in writing to the Town of Lisbon or the Lisbon Fire Department with a detailed descr1ption of how your privacy was violated and when. You also may file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
Changes to this Notice
We reserve the right to change this Notice and our privacy policies at any time. Before we make an important change to our policies, we will promptly revise this Notice and post a new Notice within our facilities. Any changes will apply to the health information we have on file and health information we create or receive after the effective date. You may request a copy of this Notice from either the Lisbon Town Hall or the Lisbon Fire Department. Effective date of this Notice, April 14th, 2003.